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Later stages
As Alzheimer's progresses, problems with memory loss, communication, reasoning
and orientation become more severe. The person will need more day-to-day support
from those who care for them.
Some people start to believe things that are untrue (delusions) or less often see
or hear things which are not really there (hallucinations).
Many people with Alzheimer's also develop behaviors that seem unusual or out of
character. These include agitation (eg restlessness or pacing), calling out, repeating
the same question, disturbed sleep patterns or reacting aggressively. Such
behaviors can be distressing or challenging for the person and their career.
In the later stages of Alzheimer's disease someone may become much less aware of
what is happening around them. They may have difficulties eating or walking
without help, and become increasingly frail.
Diagnosis
Alzheimer's disease is usually diagnosed based on the person's medical history,
history from relatives, and behavioral observations. The presence of characteristic
neurological and neuropsychological features and the absence of alternative
conditions is supportive. Advanced medical imaging with computed tomography
(CT) or magnetic resonance imaging (MRI), and with single-photon emission
computed tomography (SPECT) or positron emission tomography (PET) can be used
to help exclude other cerebral pathology or subtypes of dementia. Moreover, it may
predict conversion from prodromal stages (mild cognitive impairment) to
Alzheimer's disease.
Prevention
There is no definitive evidence to support that any particular measure is effective in
preventing AD.
Although cardiovascular risk factors, such as hypercholesterolemia, hypertension,
diabetes, and smoking, are associated with a higher risk of onset and course of AD,
statins, which are cholesterol lowering drugs, have not been effective in preventing
or improving the course of the disease.
Long-term usage of non-steroidal anti-inflammatory drugs (NSAIDs) is associated
with a reduced likelihood of developing AD. Evidence also supports the notion that
NSAIDs can reduce inflammation related to amyloid plaques. No prevention trial has
been completed. They do not appear to be useful as a treatment. Hormone
replacement therapy, although previously used, may increase the risk of dementia.